Family Care Behaviors and Early Childhood Development in Low- and Middle-Income Countries

Epidemiological evidence linking early childhood development (ECD) with family care behaviors is limited. This study assessed relationships of ECD with family care behaviors and child nutritional status in 77,315 children 36–59 months from 26 low- and middle-income countries from the Multiple Cluster Indicator Surveys round 4. We used UNICEF-recommended indicators for literacy–numeracy and learning development. Family care behaviors measured were provision of books and play materials, inadequate care, activities of adult caregivers with child, father’s involvement, attendance to early childhood education program, and violent discipline. Nutritional status was measured by height-for-age z-scores. Three-level linear mixed-model regression analysis was done separately for each ECD outcome. Both developmental domains were associated with family care behaviors, with strongest associations between literacy–numeracy and program attendance, provision of books, and stimulating activities. Differences in the proportion on track for literacy–numeracy were 0.176–0.277 for these three family care behaviors. The multivariable model controlling for maternal education and wealth showed that children with provision of books, program attendance, and four stimulating activities had a proportion of being on track for literac–numeracy that was 0.427 higher than children without these. Higher height-for-age was associated with higher prevalence of being on track for literacy–numeracy and learning development. This study provides epidemiological evidence on the importance of family care behaviors for ECD. ECD could be substantially fostered by interventions that promote appropriate family care behaviors and resources for learning stimulation even in contexts of socioeconomic and educational disadvantage.